The majority of childhood fevers are viral, for which antibiotics are not required. So if your doctor thinks the fever to be viral and prescribes at the most some antipyretic (e.g. Paracetamol), don’t think that “less” medicines are being given to your child and so how it will cure the sickness? Since most viral fevers are benign and self-limiting, they don’t require much drug therapy.
Do not take aspirin for childhood fevers, as it can, in some diseases like chickenpox and influenza, cause a serious illness to the liver and brain. The viral illness can last as long as 5-7 days. So if the child doesn’t become OK in 2-3 days, don’t panic and go “doctor-shopping”. I can understand the parents getting worried if the baby is not all right soon. It starts taxing their patience. But if the parents are reassured that the illness is self-limiting, not serious and will get all right in another 2-3 days, they will be relaxed. Parents can always seek reassurance from their doctor, (visit him again or telephone to him) who will reiterate that the child is having nothing else but a benign viral illness.
Many parents have a “fever phobia.” They think that fever should be energetically treated and brought down urgently; else it will go on rising and cause brain damage and other serious problems to the child. This is not true. In fact fever is the body’s response to infection, and plays a role in fighting it. Scientists even say that fever is useful, both as a clue to the ongoing disease process, and also because it enhances the immunity of the body
In some cases of fever, the cause of the fever may not be immediately apparent and so the doctor may follow a “wait and watch” policy (if the condition of the child is not serious) till the diagnosis becomes clearer. In the meantime he may not prescribe any medicines except paracetamol s.o.s. (Paracetamol is usually given when the fever is higher than 102° F; it will reduce the temperature but may not bring it completely to normal.) The effect of paracetamol lasts for 3-4 hours after which the fever will again start rising unless the underlying infection is taken care of.
In my opinion, this is the correct approach. Every doctor must strive to reach a diagnosis (i.e. try to find out the underlying disease responsible for fever or any other complaints). Prescribing an antibiotic, anti- malarial, anti-typhoid and other medicines as a “shotgun” therapy in the hope that one of them will hit the target and cure the disease is not correct and rational.
Sadly this happens often because the doctor wants to satisfy the parents so that he may not lose their confidence and hence the patient as his client. It is only when the parental attitudes will change and they will question the need for a concoction of 6-8 medicines together for a simple disease like viral fever that the doctor’s attitude will also change. Till that time, I am afraid; this “magic bullet” therapy will go on.
Parents often bundle their child with excessive clothing whenever they have fever, which is not a good idea (unless the child is shivering and feeling cold.) Intact the child should be dressed lightly, so that excessive heat from the body can dissipate. If sponging is to be done to bring down the fever, it should be done with tepid (lukewarm) water over as much area of the body as possible, followed by light fanning.
The principle behind this is that a light breeze blowing across the body will evaporate the water, which will take along with it its heat of evaporation from the body thus cooling it and bringing down the temperature. Cold water should not be used because it will make the child uncomfortable and he may start shivering. In my day to day practice, I often see parents putting a strip of wet cloth on the forehead for bringing down the fever. It is of limited value.
TREATING FEVER AT HOME
What is fever?
• Fever is a rise in the body temperature to 100 Fahrenheit or greater.
• Fever is the body’s natural response to a viral or bacterial infection.
• Fever is considered beneficial to help the body fight infection and usually is not dangerous.
• You may be able to realize that your child has fever by feeling his/her forehead, face or stomach, but it is not a very accurate method, particularly in low grade fever.
• Taking a temperature is the only sure way to know if your child has a fever. Normal body temperature may go up in the late afternoon or early morning.
How to take temperature?
• There are many devices to measure temperature like glass, digital or tympanic (ear) thermometers. Glass thermometer is the most common variety. It is least expensive and very accurate.
• Devices such as temperature strips which are placed on your child’s forehead are not accurate. DO NOT USE THEM.
• Taking rectal temperatures should be avoided because it is difficult to ensure safety while measuring this way.
• Remember not to leave your child alone while taking his/her temperature.
Oral temperature
• Oral temperature should be taken only if your child is cooperative and five years of age or older. Young children may bite or break the thermometer.
• Tip of the thermometer should be kept under the tongue for 2-3 minutes.
• Tell your child to close the lips tightly without biting the thermometer.
Axillary temperature
• Take your baby or young child’s temperature under the arm (axillary).
• Hold the tip of the thermometer in the centre of the armpit with one hand for 3-4 minutes.
• Axillary temperature is slightly lower than oral temperature. Table given below will help you to understand the axillary temperature readings. ADD 0.6 to the axillary reading.
Body Temperatures
Normal – Fever – High fever
Axillary – 98.0°F – 99.4°F – 104.4°F
Oral – 98.6°F – 100.0°F – 105.0°F
HOW TO TREAT FEVER AT HOME?
Without medicines
• If your child has a fever but is otherwise playful, eating and drinking, he may not need any medicine.
• Dress your child in lightweight clothes or preferably remove them to allow heat loss through the skin.
• If your child is shivering or feeling cold, use a lightweight blanket.
• Activity increases body temperature-try to keep your child quiet.
• Encourage your child to have extra fluids to prevent dehydration or extra loss of water (water, iced drinks, juices, or whatever he/ she will drink).
With medicines
• Medicines to reduce fever are needed only to make your child more comfortable.
• You can safely use acetaminophen (paracetamol) every 4 hours which can be administered in a syrup or drops form. Remember to check the dose on the bottle.
• Your doctor may advise you to use nimesulide or ibuprofen. Frequency of administration and doses differ with different antifever medication. Always check with the doctor.
• Do not use aspirin for fever (it has been related to a serious illness, Reye’s syndrome).
• Always give your child medication for fever if he/she has had febrile seizure (seizures when your child has a fever).
• Give your child a sponge bath with lukewarm water only (no cold water) if fever is higher than 104°F or if fever is not decreased 30-60 minutes after medication is given.
• Never leave your child alone in the tub.
• Stop the sponge bath if your child starts to shiver.
• Never use rubbing alcohol for baths or sponging.
• Alcohol can cool your child too quickly and can be absorbed through the skin causing alcohol poisoning.
When to call your doctor?
• If your baby less than 6 months of age has a temperature 101°F or higher.
• If your child’s fever is 104°F or higher.
• If your child has other signs of illness like vomiting, loss of playfulness or appetite.
Caution!
This information should not be considered alternative to Doctor’s advice.